Radiotherapy in nodal oligorecurrent prostate cancer.

Area of Science:

• Oncology
• Radiation Oncology
• Prostate Cancer Research

Background:

• Nodal oligorecurrent prostate cancer presents unique treatment challenges.
• Understanding recurrence patterns is crucial for effective management.
• Radiotherapy strategies are evolving for recurrent prostate cancer.

Purpose of the Study:

• To review current literature on radiotherapy for nodal oligorecurrent prostate cancer.
• To compare metastasis-directed stereotactic ablative radiotherapy (SABR) with external elective nodal radiotherapy (ENRT).
• To develop expert panel recommendations for treatment.

Main Methods:

• A comprehensive literature review was conducted.
• Studies comparing SABR versus ENRT were analyzed.
• Recurrence patterns after local nodal treatment were examined.
• The DEGRO Prostate Cancer Expert Panel discussed findings and formulated recommendations.

Main Results:

• Metastasis-directed SABR shows high local control (>90%) and can improve progression-free survival.
• Distant progression after SABR typically occurs within months.
• ENRT improves metastases-free survival but has higher toxicity than SABR.
• Nodal recurrences are often detected within the true pelvis and common iliac vessels.

Conclusions:

• ENRT is recommended for pelvic nodal recurrences in prostate cancer.
• SABR may be suitable for selected cases of distant (extrapelvic) nodal recurrences.
• Systemic treatments, including androgen deprivation therapy (ADT), should follow current guidelines.
• Further prospective studies are needed for definitive recommendations.